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A rant about podiatrists - what's going on with those folks??

Posted by Steve G on 8/29/03 at 00:56 (128339)

I just have to rant for a few minutes. I just read and responded to a note by a woman about surgery. Before I start ranting, I
want to preface all this by saying that both of the podiatrists I have had (including our very own Dr. Davis) have been consummate professionals - caring, informative, supportive of my own efforts to gain knowledge and guide my treatment. However, I have to wonder if the other pods out there are all trained in the same manner or just become incompetent and cavalier with the passage of time. After presenting with PF, this poor woman was given shots, ice, and a golf ball. When this did not seem to help, he taped her foot a few times. When she went back he told her that they had come down to surgery as her only option. She did not even mention ESWT in her note. I don't even get the impression she knows what a night splint is. Even with her limited knowledge, she wonders if the push to surgery is 'too hasty'. She needs to run out of his office like it was on fire. And if I every encountered such a doctor, Iwould have to be thrown out of his office. And this is not the first time I have seen this sort of thing. About a year ago I responded to a post by a woman that had, as a treatment protocol, some stretching and 12 shots. What on earth was her pod thinking!! If the poor woman did not rupture her fascia it was a miracle. I am truly at a loss to understand this sort of thing. Do the kidney specialists over here at Harborview have vastly different treatments for diabetic kidney damage depending on where they went to school or whether it is Thursday as oppose to Monday? I don't think so. So why do I read about these cases where people are getting treatment that even I, with my limited understanding, know is both incompetent and harmful??

There - end of rant, it's time for bed.

Re: A rant about podiatrists - what's going on with those folks??

Sharon W on 8/29/03 at 08:19 (128345)

Steve,

I wish I could answer that -- although I know it was a rhetorical question. There are good and not-so-good podiatrists, just like there are people who are good and not-so-good at anything else.

However, if anything, I think podiatrists may be a bit BETTER than MDs in that respect -- especially certain TYPES of MDs. I think I have commented here before that I don't like neurologists. Well, I just read a horrific (but presumably true) personal account written by a patient who had suffered for many years with 'idiopatic' peripheral neuropathy (severe sensory PN and gastroparesis) who FINALLY, as a result of educating herself on the 'braintalk.org' board, persuaded her neurologist to order an abdolminal fat biopsy. In the space of one phone call from the surgeon who did the biopsy, this woman went from 'you just have a progressive neurologic disease' to 'you don't have much time left...'

And THEN, UNBELIEVABLY, she got a call from her neurologist's NURSE, telling her everthing was 'fine' - that the biopsy was negative. Of course, she stopped the nurse and told her that it was NOT fine, that she was looking at the report in her hand and that the surgeon had already told her that it was positive. The nurse had her fax over her own copy of the report, and then called back later to say that the neurologist claimed he 'never got the second page' and admitted that just maybe after all the amyloidosis could be causing her severe nueropathy... (The patient said that excuse could POSSIBLY have been true, about not getting the second page... there were actually two biopsy samples, and the first one came back normal; it was the second one that showed amyloidosis. But it clearly said 'see second page' on the bottom of the first page, so he should have been looking for the other biopsy)

The jerk neurologist didn't even have the nurse pass on an apology for his mistake, much less pick up the phone to apologize himself! Yet if the surgeon who did the biopsy HADN'T called, himself, to tell her the results, she would have only been given the FALSE information that the biopsy was 'fine,' and she probably wouldn't have found out about her condition until she was on her death bed -- in fact, it sounds like the disease is already pretty far along for her to fight it.

Here's the clincher: you're probably thinking, well, she just needs to find herself another neurologist, one with a really good reputation, one that comes highly recommended. WELL, THAT WOULD BE THIS GUY!! In fact, he is out there teaching OTHER doctors how to be neurologistis...

GRrrrrrrr!!

Sharon
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Re: A rant about podiatrists - what's going on with those folks??

Dr. David S. Wander on 8/29/03 at 10:18 (128353)

Steve,

As in any profession or occupation, there are good and bad practitioners. Unfortunately, you seem to rarely hear about the good doctors or success stories, the incompetent doctors and stories of failure seem to obtain more publicitiy. You're an intelligent guy, and must understand that there are different treatment protocols, and some doctors simply don't keep up with current trends and always revert back to old habits. Don't cast a shadow of guilt over an entire profession, you're too smart for that. In your own words, you were helped by your 2 podiatrists, including Ed Davis, DPM. We can all tell you horror stories of patients that have been treated by other podiatrists, neurologists, orthopedists, etc., that enter our offices with prior treatments that bordered on incompetent or insane. Forget about those doctors, and simply seek out the best.

Re: A rant about podiatrists - what's going on with those folks??

Ed Davis,DPM on 8/29/03 at 14:59 (128378)

Steve:

Your comments are well taken. I don't really have a good answer but will say speculatively, that there are a lot of practitioners out there who are fairly 'burnt out' by the system that pushes drugs and surgery and just have decided to 'go with the flow.'

That being said, I feel that the Seattle area and the northwest, in general, have a majority of practitioners that offer good conservative care. I can compare and contract practice patterns in several parts of the US and have to give Seattle area pods fairly high marks. If you have some more specifics about the example you sighted, please email me at (email removed)

Ed

Re: A rant about podiatrists - what's going on with those folks??

Dorothy on 8/29/03 at 16:18 (128399)

It would actually be an interesting (maybe depressing or enraging) thread to post all of the personal or otherwise personal knowledge of Amazing Stories with doctors. I honestly don't think that the kind of incident(s) that you describe are uncommon. I have been in life a teacher, a counselor, a case worker, a therapist, a social worker, and other things as well that don't pertain to this thought - in those areas of work, as well as in my own personal life, I have experienced or witnessed some amazing things. Yes, some of them have been amazing in positive ways, but some were far from positive. This is one reason that I earlier said everyone needs an advocate when engaging with the medical 'system' - and even a team of advocates would be good!

Re: A rant about podiatrists - what's going on with those folks??

Ed Davis,DPM on 8/29/03 at 16:45 (128402)

Dorothy:

The doctor is supposed to be the patient advocate. Many people don't realize that managed care changed that relationship -- a change that happened all too quietly without many realizing that that happened.
Ed

Re: A rant about podiatrists - what's going on with those folks??

Dorothy on 8/29/03 at 17:25 (128405)

So true - I think doctors have written and commented on this change in their perceptions of their role with patients and patient care, and patients have certainly noted it. Nurses have also traditionally been patient advocates, but that seems to have changed as well, under the same pressures.

I just think a big diffence is in the affects of these changes. Patients feel more helpless and vulnerable, and may, in fact, BE more vulnerable. I realize that there has never been perfection in medical treatment and that the expectation of perfection is irrational. At the same time, I think each and every one of us could recount some 'horror tale' of medical care gone awry, not because perfection was an irrational expectation and unattainable, but because of easily preventable lapses. I think that it's the quality of 'attention to detail' that makes a huge difference. Whether it's in the plumber, the carpenter, the architect, the police officer, the lawyer or the doctor. We need people who lean toward the 'anal-retentive' personality if we want to have good attention to detail.

Re: A rant about podiatrists - what's going on with those folks??

Sharon W on 8/29/03 at 18:47 (128409)

Dorothy,

I think that's the first time I've EVER heard anyone advocate in favor of the 'anal-retentive' personality!!

However, you are right that the role of nurses as patient advocates has also changed. Most nurses DO still see themselves in that role... But now, more than ever, nurses are being required to work faster, to take care of more patients at one time, and to produce more and more pages of mandatory documentation. SOMETHING has to give... and all too often the only thing that CAN 'give,' is the role of patient advocate.

From personal experience I can remember evenings when I always meant to go back to a depressed patient's room, pull up a chair for at least a COUPLE fo minutes, and offer her a listening ear... but unfortunately that night I just was never able to find the few 'extra' minutes that would have taken. I really did TRY, and usually I DID manage to spend those moments with my patients that make all the difference in establishing trust and an 'advocacy' relationship. But it isn't easy to do, not easy at all. There were long nursing shifts when I never stopped for a break of ANY kind, not even to go to the bathroom -- that's how busy it was!

So I do understand where 'burnout' comes from, and why so many health professionals fall prey to it... why some people involved in health care seem to STOP caring about anything except how much longer it will be before they get to go home.

Sorry to ramble on so.

Sharon
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Re: A rant about podiatrists - what's going on with those folks??

Dorothy on 8/29/03 at 20:31 (128416)

I didn't sound like a ramble. It sounds like an informed statement of what happens. All humans, whether in the 'caring professions' or other lines of work, have their limits. I have always objected to the term 'burnout' (I don't mean your using it, but the general use of it in the 'caring professions') because it is too often used to imply that an individual has failed in some way, is 'burned out' - and usually when we think of that expression, it is followed by 'shell' as in 'burned out shell'. My experience is that could not be further from the truth. It is usually the system that the individual works in that has failed both the patients/clients and the worker trying to help. The pressures on health care workers and on the health care system are rapidly coming to a head - whether you consider the nursing shortage, closing hospitals,the numbers of uninsured, drug costs, availability of treatment, etc. etc.
I hear you.

Re: A rant about podiatrists - what's going on with those folks??

Dorothy on 8/29/03 at 20:34 (128418)

Sharon W. ~

What do you think of this:

Is there a hyphen in 'anal retentive'?' If they try to answer, you know they are.

:-)

Re: A rant about podiatrists - what's going on with those folks??

Sharon W on 8/29/03 at 22:00 (128420)

Dorothy,

I have a friend in 'psych' who prefers the term 'compassion fatigue' to 'burnout' -- and I do think that seems more accurate and descriptive of what really happens. I also like the term 'vicarious traumatization' -- that describes another component of what health care workers go through as they try to 'advocate' for their patients.

I should probably add that one way a nurse 'advocates,' traditionally, is to act as kind of a go-between for doctors and patients -- the nurse finds out what is going on with the patient and then relays to the doctor whatever info she has learned that SHE thinks the doctor really ought to know. Unfortunately, this process does mean that the patient's words and concerns are being reported to the doctor second-hand and what the nurse says to the doctor may be what the doctor acts upon, rather than the doctor responding to the patient's own words.

(I have mixed feelings about that...)

Sharon
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Re: A rant about podiatrists - what's going on with those folks??

marie on 9/03/03 at 14:33 (128703)

Your points are well taken. I think we, as patients, sometimes forget we are also consumers. If you're not happy with the first one go for a second or switch. Sometimes with a new or uncommon illness you don't really know if the doctor is doing whats best for you. I have been there with doctors and physical theropists. I think it's important for patients to ask the success rate that physician has had with treatments. How do you ask without coming across offensive? The last thing I want to do is come across offensive to my physicians as I do respect their entitlement.

marie